Preceptorship and interpersonal conflict: a multidisciplinary study

Preceptors' perceptions of assessing clinical associate students at district hospital sites

BACKGROUND

Preceptors are key stakeholders in distributed health professions' education. They supervise students in the clinical setting to enable them to have a practical experience with patients, and they assess students' skills at the highest tier of clinical assessment. The university where this study was done conducts a distributed Bachelor of Clinical Medical Practice course on a distributed platform which is dependent on preceptors at the training sites. Understanding the perceptions of preceptors, as major stakeholders, regarding the student assessment they do will assist the faculty to provide better support and development that might be needed and assist in maximising the benefits of distributed training.

AIM

The aim of this study was to explore the perceptions of preceptors regarding assessing clinical associate students at district hospitals in the Bachelor of Clinical Medical Practice programme.

SETTING

The study was conducted at a rural university in the Eastern Cape province of South Africa.

METHODS

This was a qualitative study involving nine preceptors who were purposively selected from three district hospital training sites based on their involvement in assessing clinical associate students. Semi-structured interviews were conducted, recorded, transcribed and thematically analysed.

RESULTS

Four themes emerged from thematic analysis: assessment issues, preceptor issues, student issues and university support issues. Preceptors are committed and enthusiastic in training and assessing the clinical associate students but require input from the university in terms of training and ongoing support.

CONCLUSION

Lack of training threatens the validity of preceptor assessment. Academic institutions should train and support preceptors to enable them better to fulfil their roles.

Conflict between Pharmacy Preceptors and Pharmacy Learners in Experiential Education

BACKGROUND

The relationship between a preceptor and a learner is complex and can be prone to conflict. The issue of conflict in experiential education has been studied in medicine, nursing, social work, and education; however, conflict between pharmacy preceptors and learners has not been described.

OBJECTIVE

To describe types of conflict between pharmacy preceptors and learners, the outcomes of such conflict, the impacts on the preceptor-learner relationship, and conflict-resolution strategies.

METHODS

An anonymous electronic survey of pharmacist preceptors and pharmacy residents in British Columbia was conducted. The survey included various types of questions to enrich the quality of responses (e.g., Likert scale, ranking, and requests for comments). Descriptive statistics were used.

RESULTS

Forty-nine participants completed the survey from the preceptor's perspective, 12 from the learner's perspective, and 4 from both perspectives. Sixty percent of preceptors (32/53) and 75% of learners (12/16) admitted experiencing conflict. Preceptors (n = 27) cited the learner's professionalism (74%), knowledge/skills (59%), communication issues (59%), personal issues (56%), and punctuality/attendance (52%) as causes of conflict. Learners, however (n = 12), cited differing expectations (67%), teaching versus learning style preferences (50%), and communication issues (67%) as causes of conflict. The majority of preceptors and learners indicated that conflict had negatively affected the relationship; however, most preceptors (69% [18/26]) and learners (50% [6/12]) agreed or strongly agreed with the statement, "I have generally felt comfortable working with preceptors/learners after a conflict." More learners than preceptors felt that the learner's ability to perform was negatively affected by the conflict (92% [11/12] versus 52% [13/25]). Preceptors were more likely to take initiative to resolve conflict. Verbal communication was the method of conflict resolution preferred by both preceptors and learners. Most preceptors and learners indicated that they felt that conflicts were generally resolved.

CONCLUSIONS

Conflict was common in the pharmacy preceptor-learner relationship. Pharmacy preceptors and learners had different perspectives about the causes and outcomes of conflict.

Conflict in nursing studies: A bibliometric analysis of the top 100 cited papers

AIM

This study aimed to identify and investigate the main characteristics of the top 100 most cited studies on conflict in published in nursing category in the Web of Science database using bibliometric and social network analysis methods.

DESIGN

A retrospective bibliometric analysis was used.

METHODS

The study data were obtained from the Web of Science (WoS) database. The top 100 studies with the highest number of citations were included in the study. The study data were analysed with Excel and SPSS and they were visualized with VOSviewer.

RESULTS

It was concluded that the studies in the research were published in 38 different journals between 1974-2019 and they were conducted by 245 different authors from 24 different countries. It was further reported that the Journal of Advanced Nursing was the most productive journal and the USA was the most productive country. The most commonly used keywords were "nurse," "conflict," "nursing," "job satisfaction," "work-family conflict" and "ethical conflict."

CONCLUSION

The issue of conflict is a growing field of scientific study for nursing researchers. The quality of researches will be certainly enhanced in future with the studies published in journals with high impact factors.

IMPACT

The research of the top 100 most cited paper is a new and innovative bibliometric approach to understand nursing literature. There is very little information about the development, structure and characteristics of the existing mass of knowledge on conflict in nursing studies. The study findings establish a basis of information for planning further studies and providing guidance. In addition, this study provides researchers, scientific journals, institutions and countries with an opportunity to assess and compare their own performance in conflict literature in nursing studies. However, the fact that the most cited studies in the field of conflict in nursing is in demand by journals with high impact factor is a source of motivation for researchers studying in this field.

Pair Scanning: Integrating the Student Sonographer Without Impacting Patient Care

OBJECTIVES

Ultrasound departments in Canada frequently reduce patient bookings to support student training, which impacts not only patient care but also revenue generation. Therefore, physicians and employers are reluctant to host student sonographers, and educational programs struggle to find sufficient clinical placements for their students. Two research questions were investigated: (1) Can a pair scanning technique effectively integrate the student sonographer into the workplace without impacting patient volumes? (2) Does the pair scanning technique prepare the student sonographer for entry-level practice faster than traditional practice?

METHODS

This research project was divided into 2 phases. The first phase used action research to develop the pair scanning protocol at a single site with a single preceptor and student. The second phase used a mixed methods approach to test the transferability of the pair scanning protocol across multiple sites, preceptors, and students.

RESULTS

In phase 1, the student sonographer performed a greater number of total examinations than the rest of her cohort (who were at different placement sites), and the higher performance of independent examinations by the student sonographer under the pair scanning technique was statistically significant [H₍₄₎  = 36.297; P < .01]. In phase 2, the pair scanning group and the control group performed equally, with no statistically significant differences.

CONCLUSIONS

The pair scanning protocol is effective at integrating the student sonographer into the work flow without impacting patient care. It prepares the student sonographer for entry-level practice equally with traditional practice and may be most effective with the weak to average student.

Competencies to enable learning-focused clinical supervision: a thematic analysis of the literature

CONTEXT

Clinical supervision is essential for development of health professional students and widely recognised as a significant factor influencing student learning. Although considered important, delivery is often founded on personal experience or a series of predetermined steps that offer standardised behavioural approaches. Such a view may limit the capacity to promote individualised student learning in complex clinical environments. The objective of this review was to develop a comprehensive understanding of what is considered 'good' clinical supervision, within health student education. The literature provides many perspectives, so collation and interpretation were needed to aid development and understanding for all clinicians required to perform clinical supervision within their daily practice.

METHOD

A comprehensive thematic literature review was carried out, which included a variety of health disciplines and geographical environments.

RESULTS

Literature addressing 'good' clinical supervision consists primarily of descriptive qualitative research comprising mostly small studies that repeated descriptions of student and supervisor opinions of 'good' supervision. Synthesis and thematic analysis of the literature resulted in four 'competency' domains perceived to inform delivery of learning-focused or 'good' clinical supervision. Domains understood to promote student learning are co-dependent and include 'to partner', 'to nurture', 'to engage' and 'to facilitate meaning'.

CONCLUSIONS

Clinical supervision is a complex phenomenon and establishing a comprehensive understanding across health disciplines can influence the future health workforce. The learning-focused clinical supervision domains presented here provide an alternative perspective of clinical supervision of health students. This paper is the first step in establishing a more comprehensive understanding of learning-focused clinical supervision, which may lead to development of competencies for clinical supervision.

The rules of the game in graduate entry nursing: A longitudinal case study

BACKGROUND

Graduate Entry Nursing programmes are pre-registration nursing curricula designed for candidates who already have a health related degree. The programmes aim to attract highly motivated individuals who have a commitment to nursing and hold the cognitive abilities associated with studying in higher education including critical thinking styles and capability to study independently. These attributes are termed within the literature as "graduateness". They are viewed by some as advantages to nursing. In contrast, however, there remains widespread scepticism amongst the public and some professionals towards those who are academically educated entering nursing.

OBJECTIVES

To explore how GEN students anticipate, experience, explain and respond to attitudes which imply resistance to those who are academically educated.

DESIGN

Longitudinal case study informed by the conventions advocated by Yin (2014).

SETTINGS

School of Health Sciences in a British University.

PARTICIPANTS

Eight GEN students participated over the two year duration of their programme. Twelve clinical assessors with a minimum of four months' experience of supporting GEN students in practice.

METHODS

Students took part in individual interviews at six monthly periods which were informed by the content of diaries maintained throughout their clinical placements. Clinical assessors took part in focus group discussions. Practice documentation was accessed to identify the progression of clinical competency along with written feedback received by students from clinical assessors.

RESULTS

Results demonstrate the ways in which GEN students position themselves performatively in order to pre-empt or challenge negative stereotypes relating to their competence, compassion and commitment.

CONCLUSIONS

Students employ a number of strategies to navigate the challenges of learning within an environment in which they are viewed with suspicion and distrust.

The role of the clinical preceptor: an integrative literature review

The clinical learning environment has been identified as being central to nursing education. The clinical learning environment provides undergraduate nursing students with the opportunity to combine cognitive knowledge with the development of psychomotor and affective nursing skills. The preceptor role in undergraduate nursing education is complex and multifaceted. Undergraduate nursing students identify preceptors as key to their learning in the clinical setting; however, staff nurse preceptors often feel unprepared to serve in this role. This integrative literature review explores the role of the staff nurse preceptor through the perspective of undergraduate nursing students, nursing faculty, and staff nurses who are assigned to precept students as a function of their nursing role. Recommendations are made to facilitate the preparation of clinical preceptors to fulfill this essential role in preparing nursing students for clinical practice.

Living and learning in a rural environment: a nursing student perspective

This study investigates the influences on nursing student learning who live and learn in the same rural environment.

BACKGROUND

A declining health workforce has been identified both globally and in Australia, the effects of which have become significantly apparent in the rural nursing sector. In support of rural educational programs the literature portrays rural clinical practice experiences as significant to student learning. However, there is little available research on what influences learning for the nursing student who studies in their own rural community.

RESEARCH AIMS AND DESIGN

The aim of this study was to understand what influences student learning in the rural clinical environment. Through a multiple case study design five nursing students and two clinical preceptors from a rural clinical venue were interviewed. The interviews were transcribed and thematically analysed to identify factors that influenced student learning outcomes.

RESEARCH FINDINGS

The most significant influence on nursing student learning in the rural clinical environment was found to include the environment itself, the complex relationships unique to living and studying in a rural community along with the capacity to link theory to practice. The rural environment influences those in it, the demands placed on them, the relationships they form, the ability to promote learning and the time to teach and learn.

Ethical concerns in the student/preceptor relationship: a need for change

Nursing schools are required to ensure that the clinical and academic milieu prepares nurses not only to recognize but also to act on various ethical issues. As a result of our years teaching nursing ethics to undergraduate nursing students we have come to believe there is a disconnect between classroom teaching and students' experiences in practice. How then can nurse educators help nursing students not only to see the ethical components of their work but also to take the necessary steps to solve ethical dilemmas and challenge unethical practice? One such strategy is the use of preceptorship. In this paper, we set out to learn about nursing students' ethical encounters in the clinical area, specifically those within the preceptor/student relationship. To this end we conducted an integrative review and are weaving in Gesler's (1992) concepts who argued that ethical issues play out in our physical and social environments. We identified nine articles that describe students' perceptions of ethical problems in their relationships with preceptors. However, it was rare for the authors of these articles to label these as 'ethical' issues. The integrative review revealed first, that students describe ethical issues in their narratives, and second, their most common response to these issues is silence. We continue to be concerned that nursing students' classroom learning of ethics is disconnected from their everyday nursing practice. Further research and education implications are discussed and explored in this paper.

Generational clashpoints in nursing preceptorship

The success of the preceptorship approach to teaching-learning depends on the formation of positive working relationships. Preceptors and nursing students are frequently of different generations and often have differing world-views. A phenomenological study, guided by van Manen's approach, was conducted to develop an understanding of how generational differences influence the formation of the preceptor-student relationship and the overall success of the experience. Three main themes were revealed: being affirmed, being challenged, and being on a pedagogical journey. A key subtheme of being challenged was colliding generational worldviews; in this article, our purpose is to explore this particular subtheme. The data suggest that generational clashpoints are occurring during preceptorship experiences, and the implications of these are serious, particularly from a nursing recruitment and retention perspective. It is vital that proactive measures be taken to inspire the future generation of nurses, rather than stifling their spirit and assertiveness.

Making a difference: the value of preceptorship programs in nursing education

The benefits of clinical nursing experience in nursing education cannot be overemphasized. Literature has shown that proficient clinical nursing education enhances nursing practice through the development of professional growth with opportunities for the application of theoretical knowledge. Clinical preceptorship has been shown to be an effective method in the development of professional nurses through clinical education. The role of a clinical nursing preceptor is complex and not necessarily applicable to all nurses. Understanding the clinical environment, comprehending individual learning styles, and dealing effectively with conflict are skills that an effective preceptor needs to acquire before participating in the role. This article describes the origin of the preceptor role in clinical nursing education and discusses how the role can be enhanced through a proficient and well-planned preceptorship education program.

Horizontal violence and the socialization of new nurses

This article discusses research on horizontal violence in nursing, focusing on the cycle of horizontal violence within nursing education and how it impacts the socialization of newly graduated nurses. Michel Foucault's (1969,1980) work is used to provide a framework for understanding the socialization of nurses and for addressing horizontal violence experienced by nursing students, to help them prepare for the work environment.

A Literature Review of Preceptorship: A Model for the Medical Radiation Sciences?

Preceptorship is a time-limited, education-focused model for teaching and learning within a clinical environment that uses clinical staff as role models. Its primary goal is to assist new staff and students to adapt to their roles, develop clinical skills and socialize the novice to a department or institution. It has been widely used within the allied health professions; however, very little is known of its practice within the medical radiation sciences. The purpose of this paper was to review the literature available regarding the practice of preceptorship within the medical radiation sciences as well as provide a general overview of the key components to consider in any application of preceptorship. Key findings have been categorized into the following components: evolving definitions of preceptorship, purpose of preceptorship, benefits, roles within preceptorship, qualities of a good preceptor, drawbacks, structured and self-directed preceptorship programs.

Tailoring a graduate nurse program to meet the needs of our next generation nurses

Graduate Nurse (GN) transition into clinical practice is recognised by nursing academics and clinicians alike as being problematic on a number of levels, particularly around GN support. The general consensus is that Graduate Nurse Programs (GNP) provided by health care organisations are the most effective strategy for providing support to GN during their first 12months in clinical practice. This study reports on the redevelopment of an existing GNP in response to GN feedback. The new GNP incorporated specific strategies to meet the needs of the newest cohort of Graduate Nurses - Generation Y. Evaluation of the new GNP was undertaken through on-line surveys and two focus groups. The findings confirmed that GNs continue to experience stress and anxiety during their first year, but this can be mitigated by participation in a formal GNP which has a strong focus on support and socialisation. Further, by directing attention toward meeting some of the more specific needs of Generation Y GNs the retention of this valuable resource can be increased. In 2009, the retention of GN for the 12months following completion of the GDP was 88% compared to 64% in 2008.

Conflict in schools: student nurses' conflict management styles

BACKGROUND

Unless conflicts between the students and the instructors can be successfully managed, they will certainly result in negative outcomes for the students. The conflict management styles of the students should be recognized in detail in order to attain positive outcomes in regard to the conflict management styles.

AIM

The purpose of this study was to examine the conflict management styles used by nursing students in conflict with faculty members and the differences in use of style from the aspect of some variables.

METHODS

This study was conducted with 151 students in a public university nursing school. Data were collected using a personal information form and the Rahim Organizational Conflict Inventory II (ROCI II). The data were analyzed using descriptive statistics, ANOVA, Tukey test, Kruskal Wallis test, Mann-Whitney U test and Cronbach alpha coefficient analyses.

FINDINGS

The students were found to use integrating (X=3.82) and obliging (X=3.81) styles the most, and dominating style (X=3.02) the least. In addition there were differences determined in management style between classes, frequency of experiencing conflict, and feeling of success in the conflict (p<0.05). It was determined that the integrating and obliging styles were used more by those who evaluated themselves as successful in conflict management, but the avoiding and compromising styles were used more by students who evaluated themselves as unsuccessful.

CONCLUSIONS

It was determined that the students preferred to use styles that produced positive results in conflict resolution and that the frequency of experiencing conflict and the feeling of success in conflict had an effect on choice of style. It will be helpful to analyze the relationship between the causes of conflict between the student and the instructor in the practice field and the uses of conflict management styles.

An overview of practice education models

Educating nursing students for entry level practice in complex health care settings is a concern in Canada and many other countries. National groups have called for improved practice education to better prepare students for actual practice. The purposes of this paper are identification and critical analysis of current practice education models. Ten basic model types were identified in the literature: faculty-supervised practicum, preceptorship, education unit, joint appointment, secondment, affiliate position, internship, co-operative education, work-study and undergraduate nurse employment. Key features, benefits and limitations of each model are discussed. Emerging developments in practice education are increased inter-professional and community-based practice education, and new partnerships among academic and practice organizations. These developments are intended to alleviate model limitations, ease pressures from organizational contexts and respond to large integrated health care systems. Evidence-based research for practice education is beginning to be apparent. Further research is needed that compares models and examines learning, patient care outcomes and costs.

Medical student evaluation of faculty in student-preceptor pairs

BACKGROUND

Students' willingness to provide candid feedback about faculty in student-preceptor pairs is unknown. Strategies addressing this in U.S. medical schools have not been reported. This study describes student comfort in evaluating preceptors and how medical schools obtain/use evaluations of preceptors.

METHOD

First- and second-year medical students at Virginia Commonwealth University completed a survey at midyear and year end. A Web-based survey of U.S. medical schools was conducted.

RESULTS

Two hundred eighty-two (78%) students and 84 (70%) medical schools responded. Most students felt comfortable providing feedback to program faculty (95%), whereas fewer felt comfortable with the preceptor (77%). Students commented on both the importance and awkwardness of giving feedback. Approximately 75% of medical schools agreed that lack of anonymity limits student candor on preceptorship evaluations.

CONCLUSIONS

Understanding the impact of one-to-one ratio on student evaluations of faculty may enable programs to develop more effective evaluation strategies.

Professional roles and communications in clinical placements: A qualitative study of nursing students’ perceptions and some models for practice

BACKGROUND

Research evidence suggests that clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these 'remote' settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment.

OBJECTIVE

In this context, this study investigates the experiences and perceptions of students relating to their clinical placements and, in particular, their views on professional structuring. Specifically it addresses the roles of, and communications between, the key academics, clinical professionals and institutions responsible for their organization.

METHODS

Focus group discussions with students (n=7) and an interview survey of ex-students (n=30) each from two British universities in Southeast England.

FINDINGS

The research highlights the diverse experiences that student receive on clinical placements, as well as their own suggestions for improvements. Student informed models of worst, minimum, current and best practice are then presented, as well as a cross-setting evaluation feedback model. These highlight responsibilities and communications across health professionals and educational sites. The models include an emphasis on the roles of ward managers, mentors, link tutors and more generally on shared but clearly delineated institutional responsibility for quality assurance mechanisms. They offer the opportunity to improve educational practice in clinically-based education and concurrently to improve student experiences and outcomes.

CONCLUSIONS

Clinical placements are designed to provide practical learning through a 'slice of practice life'. However, it is necessary to maximize this learning experience. Placements certainly need not be the worst slice.

Evaluating Student Performance in Undergraduate Preceptorships

This article explores the challenges in evaluating student performance in preceptorships based on data collected during academic years 1999-2002, which revealed an unusually large number of high grades and relatively few average grades. Multiple perspectives are explored, including preceptor issues of selection, orientation, recognition, role conflict, and experience with giving grades; faculty issues of role confusion and unclear expectations for student performance; and environmental issues of lack of control of the learning environment and differences in the values of education and workplace. Solutions are proposed, including an orientation for preceptors and faculty, ongoing faculty mentoring of preceptors, official preceptor recognition, clear articulation of expectations for student performance and faculty site visits, and creation of grading rubrics for various aspects of the course to be used by preceptors, faculty, and students.

Mastering the preceptor role: challenges of clinical teaching

This article aims to help both experienced and new preceptors become more effective teachers while maintaining their clinical workloads. A variety of strategies is essential to increase teaching effectiveness and decrease stress for the busy preceptor who juggles the roles of teacher and clinician. The article will begin with a review of role expectations and role strain factors for student, faculty, and preceptor. Principles of clinical teaching will be identified, followed by some strategies for teaching on busy days and concluding with suggestions for dealing with difficult students.

New graduate nurse self-concept and retention: A longitudinal survey

Graduate nurse attrition is an increasing phenomenon within a world of decreasing nursing numbers. The newly developed nursing self-concept of the graduate nurse may provide a key indicator for predicting graduate retention. This study explores the development of multiple dimensions of nursing self-concept and examines their relationship to graduate nurse retention plans. A descriptive survey design with repeated measures was utilised to assess nurse self-concept and retention plans. The key findings suggest that multiple dimensions of graduate nurse self-concepts rise significantly in the second half of their graduate year and that nurse general self-concept is a strong predictor of graduate nurse retention. The implications of this study are that monitoring of self-concept throughout the transitional period for new nurses can lead to early detection and appropriate intervention strategies thereby improving retention rates for new nurses.

Place(ment) matters: students' clinical experiences and their preferences for first employers

BACKGROUND

Although a significant volume of nursing research has focused on students' experiences of clinical placements, to date, none has considered these experiences in the context of workforce recruitment and specifically how they may impact upon preferences for working for health care providers.

METHODS

In this context, the research used a place-sensitive geographical perspective and a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) method to collect data on the complex range of clinical experiences which together impact upon the perceived attractiveness of different health care settings.

FINDINGS

The data identified a range of experiential factors associated with mentorship, ward management, learning opportunities and racism. An important finding was that although students' experiences are obtained at the micro ward level, even if they may not necessarily reflect what happens throughout the hospital, they potentially impact, both positively and negatively, upon their broader perceptions of the hospital and the likelihood of seeking work there.

IMPLICATIONS

The study highlighted a variety of issues that should be addressed by both higher education institutions and hospitals so that they may be able to provide a more consistent and positive experience for students. In the longer term, this may pay dividends through increased recruitment of new graduates.

Using a communication audit to improve communication on clinical placement in pre-registration nursing

This article describes a novel communication audit conducted with those concerned with the practice placements of pre-registration Nursing students. The study, uniquely, addressed all who were involved in communication concerning placement in what is described as an organisational analysis. The aim of the audit was to identify levels of satisfaction and dissatisfaction with present communication processes and to identify points for improvement. The audit used the Hogard-Barker Communication Audit of Practice a customized version of a well established tool, devised to cover issues relevant to practice placements. A key feature of the tool is the opportunity for participants to identify the amount of communication they are receiving on particular topics and issues against the amount they would like to receive. Participants in the audit included students, assessor mentors, ward managers, clinical facilitators and link tutors. Overall there was considerable dissatisfaction with what was perceived to be the insufficient amount of communication received on a number of topics including allocations, the curriculum, students' learning outcomes and commitments in terms of college work. In addition to identifying points for improvement the audit provides a baseline against which progress can be assessed through a future audit.